This proposal describes two distinct but complementary projects designed to improve the performance of health care organizations on a broad scale. The first project relates to performance measurement- an indicator-based approach to measuring quality of care. The goal of the performance measurement project is to demonstrate the impact of evidence-based performance measurement on health care quality across hospitals in the United States. Specifically, the study will examine the ability of nationally implemented performance measures to influence those processes of hospital care that have direct bearing on improved patient outcome. This project will be based on hospital core performance measures that have been introduced as part of the Joint Commission's ORYX initiative in the areas of congestive heart failure, acute myocardial infarction, community-acquired pneumonia and pregnancy. The usefulness of performance measures for improving health care quality will be addressed within a multidimensional framework, including perception of value, action taken, and the impact of intervention. The second project, under the supplemental funding option noted in the RFA, addresses an essential element of overall preparedness of health care organizations for a bioterrorism event- namely establishing strong linkages to relevant community entities. The overall goal of this project is to assess improvements in linkages between health care organizations, the public health infrastructure, and emergency response entities in the wake of multiple influences such as implementation of revised Joint Commission emergency management standards, occurrence of national events and provision of federal funding for bioterrodsm preparedness. Using a mailed survey with on-site verification, we propose to evaluate change over time on linkage related items consistent across previous surveys, conduct a comprehensive cross sectional assessment of existing linkages, assess health care organization preparedness activities over the last five years, and identify exemplary practices related to linkages. The sample will consist of two types of health care organizations: a nationally representative sample of accredited hospitals and a convenience sample of accredited community health centers. The Joint Commission is uniquely positioned to conduct these projects because of its national stature and leadership role in the measurement and oversight of health care quality and its ability to influence change through consensus. Together, these projects aim to provide information about the overall usefulness of performance measurement to improve care and to identify opportunities and effective strategies for improving coordination and communication among key entities responding to bioterrorism events.